Learning Curve for Endoscopic Submucosal Dissection With an Untutored, Prevalence-Based Approach in the United...

Area of Science:

• Gastroenterology
• Endoscopy
• Surgical Oncology

Background:

• Endoscopic submucosal dissection (ESD) is a key technique for early gastrointestinal neoplasm resection in Asia.
• Its adoption and training in Western countries remain limited.
• Understanding the learning curve is crucial for expanding ESD in the Americas and Europe.

Purpose of the Study:

• To determine the learning curve for endoscopic submucosal dissection (ESD) in a high-volume US referral center.
• To establish proficiency benchmarks for ESD training programs in Western countries.

Main Methods:

• Retrospective analysis of 540 consecutive ESD procedures performed by a single operator (2009-2017).
• Evaluation of en bloc resection rates (>90%), R0 resection rates (>80%), and resection speed (>9cm²/hr).
• Analysis of case volumes required to achieve proficiency benchmarks.

Main Results:

• En bloc resection rates improved from 76% to 98% by 250 cases; R0 resection rates increased from 45% to over 80% by 250 cases.
• Resection speed benchmarks required approximately 170 (esophagus), 150 (stomach), and 280 (colon) ESDs.
• Proficiency benchmarks were achieved after approximately 250 cases using an untutored, prevalence-based approach.

Conclusions:

• Western ESD training may require more cases than in Asia due to early exposure to complex lesions.
• An untutored, prevalence-based approach enabled proficiency achievement around 250 cases.
• These findings can inform the development of ESD training programs in the Americas and Europe.